Facial

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Skin Conditions








Skin Care Products

















































Disclosure/Consent Statement
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform the esthetician/skin care therapist of my current medical or health conditions and to update this history. The treatments I received here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.


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